Injections

Question 1

What are the 8 rights of medical administration?

Answer 1

Right medication, right dose, right patient, right time, right route, right response, right reason, and right documentation.

Question 2

What are the 3 label checks of medication administration?

Answer 2

1. Check label when taking medication from storage
2. Check label before removing meds from container
3. Check label before discarding or replacing med container + giving to the patient.

Question 3

Define injection

Answer 3

Giving a medication using a syringe and needle

Question 4

What route does an injection use?

Answer 4

Intramuscular (IM)

Question 5

Why are injections great for administering large amounts

Answer 5

The medication is injected into the muscle layer lying beneath the subcutaneous layer of the skin which allows for larger amounts of medicine due to the increased rate of blood supply therefore the absorption rate is quicker

Question 6

What needles are used for Intramuscular Injections?

Answer 6

Usually 23G or 21G

Question 7

What angle is an injection usually injected at?

Answer 7

90 degrees

Question 8

Do we need to provide privacy for injections?

Answer 8

Yes

Question 9

What do we do before preforming the injection?

Answer 9

Safety checks, hygiene checks, identify patient, explain procedure, select and expose site, provide privacy and clean the site (from the centre outward).

Question 10

What do we ask the patient to do as we insert the needle?

Answer 10

Ask the patient to take a deep breath and exhale slowly to relax muscles (lessens pain)

Question 11

How much of the needle should you insert?

Answer 11

3/4 of the needle at a 90 degree angle

Question 12

How should you insert the needle?

Answer 12

At a 90 degree angle, quickly in a dart like motion, inserting 3/4 of the needle.

Question 13

What are the next steps after inserting the needle?

Answer 13

Gently aspirate aka pull back the plunger and watch for blood. If this is the case you will need to try again. Slowly inject the medication and then withdraw the needle quickly without bending or twisting it.

Question 14

What are the steps for after you take the needle out?

Answer 14

Use pressure on a piece of gauze/cotton wool ball to stop any bleeding, dispose the needle directly into sharps container, remove gloves and wash hands. Then chart site used/amount/and type of medication.

Question 15

Define ventrogluteal site.

Answer 15

The ventrogluteal injection site is an area on the most prominent part of the hip that’s considered the preferred site for intramuscular injections

Question 16

Define palpate

Answer 16

The process of examining part of the body by careful feeling with the hands and fingertips

Question 17

Define anterior

Answer 17

Describing or relation to the front (ventral) portion of the body or limbs

Question 18

Superior

Answer 18

Situated uppermost in the body in relation to another structure or surface

Question 19

How do you know where to inject in the Ventrogluteal site?

Answer 19

Simply place the palm of your hand over the greater trochanter (hip joint), index finger over the anterior superior iliac tubercule, and middle finger along the posterior iliac crest. Inject perpendicular (90 degrees) into the centre of the V formed by separated fingers

Question 20

Define vastus lateralis

Answer 20

The vastus lateralis muscle is located on the lateral side of the thigh

Question 21

What is the Dorsogluteal site?

Answer 21

The site in the thick muscles of the buttocks.

Question 22

What is the first method (quadrant method) for IM injections in the dorsogluteal site?

Answer 22

Divide the buttock into imaginary quadrants. The vertical line extends from the crest of the ilium to the gluteal fold, and the horizontal line extends from the medial fold to the lateral aspect of the buttock. Locate the upper aspect of the upper outer quadrant and ensure you palpate the crest of the ilium so that the site is high enough. Inject at this upper outer site.

Question 23

What is the second method for injecting at the Dorsogluteal site?

Answer 23

Palpate the posterior superior iliac spine and then draw an imaginary line to the greater trochanter of the femur. This line parallels the sciatic nerve. The injection site is lateral and superior to this line.

Question 24

Of what age can we not use dorsogluteal injections for?

Answer 24

Under 3 years as this muscle is developed by walking

Question 25

Define ilium

Answer 25

the large broad bone forming the upper part of each half of the pelvis.

Question 26

Define the sciatic nerve

Answer 26

Sciatic nerve is the nerve originating in the lower spine as nerve roots exit the spinal cord and extends all the way down the back of the leg to the toes

Question 27

What is the deltoid site?

Answer 27

The lateral aspect of the upper arm

Question 28

Why is the deltoid injection site not often used?

Answer 28

Because its a relatively small muscle and very close to the radial nerve and artery.

Question 29

How do we locate the densest part of the deltoid muscle?

Answer 29

Palpate the lower edge of the acromial process and the lower midpoint, in line with the axilla of the lateral aspect of the arm. A triangle within these boundries approximates the location of the deltoid muscle (about 5cm, 2inch) below the acromial process.

Question 30

What is the Z-Track method?

Answer 30

A method used to prevent leakage and help seal the drug into the muscle.

Question 31

How do you preform the Z-track method

Answer 31

Using your non-dominant hand, pull the skin and subcutaneous tissue 2-3cm sideways and insert the needle with a quick dart like motion at 90 degrees. Aspirate checking for blood if none slowly inject needle. Withdraw needle quickly and release skin to create a disjointed pathway locking the medication in.

Question 32

What is a subcutaneous injection?

Answer 32

An injection that is administered as a bolus into the subcutis aka the layer of skin directly below the dermis and epidermis collectively referred to as the cutis.

Question 33

Why is a subcutaneous injection given?

Answer 33

Because there is little blood flow to fatty tissue therefore it is absorbed more slowly sometimes over 24 hours.

Question 34

What are some medication that can be injected subcutaneously?

Answer 34

Growth hormone, insulin, epinephrine, and other substances.

Question 35

Whats involved in "Pre-Administration" of a subcutaneous injection?

Answer 35

Wash hands, check colour and clarity of medication, check expiry, check 8 rights, and check allergies and adverse reactions.

Question 36

Whats involved in the single administration (subcutaneous injection)?

Answer 36

Prepare medicine (pull the syringe plunger back until the volume of air in the syringe equals the volume of drug to be withdrawn from the vial. Insert needle and inject the air, invert the vial and withdraw prescribed amount of solution), do 8 rights check and explain procedure, select appropriate injection site, gently grasp the skin between thumb and forefinger and insert about 5mm into the skin fold at 45/90 degree angle, release the patients skin on insertion of the needle. Gently inject and remove the needle and discard immediately.

Question 37

What is a subcutaneous fluid admission for?

Answer 37

Maintenance fluid replacement only.

Question 38

Hypotonic solutions that can be administered subcutaneously include:

Answer 38

Normal saline 0% Dextrose 4% + Saline 0.18% Dextrose 5%

Question 39

Can you administer hypertonic solutions subcutaneously?

Answer 39

NO

Question 40

Subcutaneous fluids must be prescribed on what chart?

Answer 40

The IV fluid Prescription Chart (4080)

Question 41

How often should Subcutaneous fluid administration sites be monitored and what for?

Answer 41

Every 4 hours in the inpatient setting and observed for excessive swelling, leakage, dislodgement, inflammation or signs of infection.

Question 42

What is a cannula?

Answer 42

A cannula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of samples.

Question 43

How often should you change a cannula for a subcutaneous fluid administration?

Answer 43

Every 72 hours or earlier